Magazine article Behavioral Healthcare Executive

Using Technology to Connect the Dots

Magazine article Behavioral Healthcare Executive

Using Technology to Connect the Dots

Article excerpt

In 1993, William A. Anthony, PhD, director of the Center for Psychiatric Rehabilitation at Boston University, declared that the 1990s should be called the "Decade of Recovery."1 While many definitions of recovery were offered since then,2 the Center's work has been guided by a parsimonious definition of a person's recovery: "the development of new meaning and purpose in one's life as one grows beyond the catastrophe of a mental illness."1

No matter what definition of recovery one prefers, the vision of recovery has entered the mental health field as a genuine hope for the millions of Americans living with mental illnesses. Fueled by the consumer self-help movement, more effective and less harmful medications, longitudinal research showing evidence for recovery outcomes, and new service delivery models, the recovery vision has manifested itself in people returning to work, living independently, and attending school and training programs.

Simultaneously, people are asking, "If recovery is real, can it be measured in realworld outcomes such as earnings, degrees, and reduction of benefits, as well as more intangible variables such as self-esteem, empowerment, and hope?" Furthermore, even if we agree on recovery outcome measures, how can we measure what factors are determining these outcomes? Are some programs better at helping people reach these outcomes and, if so, what intervention processes are most effective?

The Value of Measurement

In our quest for evidence-based mental health interventions, it is not enough to measure program structures and outcomes. We must know how the intervention's clinical process helps to bring about recovery outcomes. Monitoring and improving a program's outcomes are most relevant if we can link the clinical process to the outcomes achieved.

To deploy true recovery-oriented mental health services, providers need to examine the effects of their services and dynamically adjust those services to optimize recovery. Unfortunately, most programs have limited resources and are unable to perform these types of evaluation. Many mental healthcare programs, therefore, have not established effective, reliable measurements of their performance.

A Technologic Solution

Boston University, via the Center, has created ROMlS, a Recovery-Oriented Management Information System designed to assess intake, process, and outcome measurements in mental health services. Conceived during the 1990s, ROMIS was the result or two years of discussions among senior staff to describe and define various service processes (e.g., rehabilitation, case management, treatment) as accurately and completely as possible.

Karen Danley, a brilliant and innovative force in vocational rehabilitation who worked at the Center for 17 years until her death in 1997, said of those discussions, "We knew that if we could get down on paper a common, logical, and objective description of the service processes, we could create a management information system that would hold the field's feet to the fire in regards to facilitating recovery outcomes."

Danley's words were prophetic, as the field in the past ten years has moved toward evidence-based practice and has begun to recognize the need to be able to describe and measure the processes producing recovery outcomes.3

Funded by consecutive grants from the lower Foundation and the Fidelity Foundation, Center staff first developed, field-tested, and refined a paper-and-pencil version of ROMIS designed to measure recovery processes and outcomes. Next, we constructed a Microsoft Access version and repeated the field tests. The rapid shift from an office-based workforce to one that is much more mobile necessitated ROMIS's migration to a Web-based design (figure).

ROMIS is accessible by any Web browser and is being tested against Internet Explorer 6.0 for Windows, Firefox 1.5, and Safari 1.3. Our goal has been to make ROMIS quickly accessible, easily usable, and able to precisely track required intake, process, and outcome information. …

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